Neuropathy

“ Like PHN, risk for TN increases with age. Incidence was found to increase to 17.5/100,000/year for ages 60–69 and 25.6/100,000/year after age 70 [2] . Although there are many idiopathic cases of TN, it has been found to be comorbid with such disorders as arterial hypertension, Charcot-Marie-Tooth neuropathy, and glossopharyngeal neuralgia [2] . ”

“ While the complicated nature of nerve diseases requires very careful treatment of great individual variety, the general rule is that the re-enforcement of the nerves with the material of which they are built, together with regeneration of the blood, which, when in normal condition prevents such disturbances, will bring about a cure. Of course this is sometimes a slow process, especially when, as in the case of epilepsy, the nervous disease is of an hereditary character, and the resistant power of the nerves is correspondingly weak. ”

“ The damage may consist of an effusion of blood between the nerve fibres following compression of a nerve against the bone by rapid passage of a foreign body near the nerve. Sometimes, however, the lesion which causes damage to the nerve trunk without actual destruction to the axis cylinders is nothing more than a temporary anemia or hyperemia. In most instances, both motor and sensory function are together interfered with, but in the case of large nerve trunks, e.g., the popliteal, there may be a separate concussion of motor or sensory bundles. ”

“ Peripheral irritation of a particular sensory nerve may evoke neuralgic pains in nerves connected with that irritated only through the spinal centre. (3) Neuralgia in a sensory nerve may (and almost always does, to some extent) produce secondary vaso-motor paralyses: these paralyses may affect fibres which run in the same branch of the nerve as that which is painful, or fibres that run in another branch of the same nerve, or fibres that run with another sensory nerve, or the ganglionic chain of the sympathetic itself. ”

“ With the field thus narrowed for us, it is surely legitimate, in the necessary scarcity of anatomical records referring directly to the state of the nerve-roots in ordinary neuralgia, to place great weight on the facts of a disease like locomotor ataxy, in which the main anatomical change is a progressive atrophy of the posterior columns which usually falls with peculiar severity on the posterior nerve-roots, or on the parts of the gray matter immediately adjoining these, and in which neuralgia may be said, for practical purposes, to be a constant and most characteristic phenomenon. ”

“ From the ascendency of the nervous system in the physical and mental composition, diseases of the nerves are very liable to appear, but not as a primary derangement any more than as a complication grafted upon some previously-existing disease. Nervous headache, neuralgia, epilepsy, insomnia, and hysteria, are among the nervous affections most liable to appear, either as primary or secondary derangements. With this class it is difficult to give an opinion as to the result in any serious disease (prognosis) , as they often die of diseases that in other temperaments are deemed trifling ”

“ Some weeks or months after the injury, the patient complains of increasing hyperaesthesia and of neuralgic pains in the course of the nerve. The nerve is very sensitive to pressure, and, if superficial, may be felt to be swollen. The associated muscles are wasted and weak, and are subject to twitchings. There are also trophic disturbances. It is rare to have complete sensory and motor paralysis. The disease is commonest in the nerves of the upper extremity, and the hand may become crippled and useless. ”

“ Its most striking teaching is the fact that the acutest agonies of neuralgia can be felt in a nerve, the central end of which is reduced to such a pitch of degeneration that conduction between centre and periphery must very shortly have entirely ceased had the patient lived. And hardly less important is its illustration of the fact that permanent injury to the ganglion of the posterior root of a spinal nerve impairs the vitality of the posterior root itself—a fact which has been independently made out by the physiological researches of Bernard and of Augustus Waller. ”

“ For the great majority of neuralgias it is quite useless, and, what is more, proves often so depressing as indirectly to aggravate the susceptibility of the nervous system to pain. The conditions, sine quis non, of its effective employment seem to be the following: The general nervous power, as shown by activity of intelligence, and capacity of muscular exertion and the effective performance of co-ordinated movements, must be fairly good, find the circulation must be of at least average vigor; the patient must not have entered on the period of tissue-degeneration. ”

“ Neuralgia and Headache.—In the grown person neuralgia, as many of us know to our cost, is by no means infrequent; in the child it is very rare, and when a child complains of severe pain in the head, or of severe pain to the knee or hip apart from rheumatism, it is almost invariably the sign of disease of the brain in the one case, of the hip-joint in the other. To this rule there are indeed exceptions, but it will always be well to leave it to the doctor to determine—no easy matter by the bye—whether any given case is one of the rare exceptions or not. ”

“ How often we hear that and how little does the person with steady nerves appreciate the tortures of "nerves."
A cut, a bruise, a headache, or any of the physical ailments can be quickly cured. Nature will mend the break, but tired, worn, stretched, abused nerves take time to restore. These nerve ailments call for most vigorous mental treatment.
Neurasthenia means debilitated or prostrated nerves and it shows itself first of all by worry. Worry means the inability to relax the attention from a definite fear or fancied hard luck. Worry leads to many physical and mental disorders. ”

“ There remain for consideration, however, (a) a small class of cases of nerve-wounds in which the healing process is not simple; but the lesion is followed by the development of a tumor of the kind denominated true neuroma. The process consists of hyperplastic changes in the nerve-fibres; its commonest examples are seen in the extraordinarily painful swellings that occur on the ends of nerves left in stumps after amputations; but, in fact, a neuroma of this kind may occur after any kind of severe nerve-injury, as, e. g., a cut from broken glass, the impaction of foreign bodies, etc. ”

“ That analogous changes take place in the vessels supplying the spinal centres is certain; but it is a remarkable fact that these do not very commonly produce motor paralysis. What they do produce is rather a slow enfeeblement both of (spinal) sensation and motion, but where the process of decay has been prematurely forced, or the inheritance of neurotic weakness is very marked, the process of sensorial decay (the decline, that is, of true sensorial function) is apt to be mingled with pain. ”

“ Examination showed nonorganic nervous disorders, consisting in a variable and patchy anesthesia of the legs, anesthesia of the conjunctiva and pharynx, and over-reaction, with sighing, during the course of the examination. The organic signs were: exaggeration of tendon reflexes, equilibration disorder, and incapacity to stand on one foot or execute a half turn or to stand still with eyes closed, and disorder of position sense. The lumbar puncture showed no cells, a slight globulin reaction, and an albumin titer within the normal. ”

“ I do not know how the facts may affect the reader, but to me they suggest the strongest possible arguments against the belief that peripheral irritation can of itself produce neuralgia without the intervention of some centric change. The tendency to such change (from inherent constitution) in the sensory root of the nerve must surely be the reason why neuroma causes neuralgia in a given number of subjects, instead of letting them go scot-free, as it does other persons. ”

“ If perturbation of nerve-function—a disturbance quite different from mere exaltation of the normal development of nerve-force—be the essence of pain, how comes it that pains of the severest type may be produced by changes in structures which are usually described, for practical purposes, as lying outside the nervous system? We must, in the first place, remark that the externality of any bodily tissue to the nervous system is more apparent than real. ”

“ Counter-irritation, heat, cold, electricity, may all be tried in vain, and as a last resource against pain, ulceration, and perverted nutrition we may be obliged to resort to nerve-stretching, or neurotomy. Under the head of Neuritis much must be said of treatment applicable to the inflammation, acute and chronic, resulting from nerve-injuries. ”

“ It is remarkable that neither the impairment of sensation nor the paralysis is, as a rule, strictly confined to the areas of distribution of particular nerves, but is diffused over regions of the body. Thus in the limbs the motor and sensory symptoms are most marked at their extremities, gradually diminishing toward the trunk. In some cases multiple neuritis appears to have occasioned the inco-ordinate movements of locomotor ataxy. In the progress of the disease a rigidity and contracted condition of muscles may be developed, occasioning a fixed flexion of some of the joints. ”

“ In some cases they are the seat of clonic spasms or twitching. Under a current of electricity they show a decreased irritability which bears a direct relation to the grade of degeneration which has occurred in the nerve fibres. In cases of deep-seated neuritis paralysis may be the only appreciable symptom. In traumatic injuries like bruises of the seventh nerve or fracture of the sacrum the local swelling and tenderness are marked initial symptoms, upon which supervene the paralysis and atrophy of the muscles cut off from full innervation. ”

“ Occasionally there are abnormal sensations (paræsthesiæ) , formication, numbness, etc., in the distribution of the nerve affected, and when from pressure or histological changes the fibres are destroyed anæsthesia results.
The interference with the conductivity of the motor fibres, which occurs less frequently than alterations of sensation, shows itself in cramps, tumors, paresis, and paralysis, according to its degree.
Neuromas may destroy life by the continued excessive pain, which wears down the strength and depresses the vitality. Death may be caused by their peculiar situation ”

“ In fact, as far as one can judge in the absence of any precise information as to the condition of the nervous centres in such cases, it would seem likely that the ordinary cases of spinal irritation differ from the true neuralgias chiefly in this—that the injury, or inherited weakness of organization, or both, which is at the root of the malady, is at once slighter in degree, and spread over a larger tract of the nervous centres, than that which produces a true neuralgia. ”

“ It is possible that the same cause is not present in every case. Still, sufficient evidence is to hand to justify the probability that neuritis is dependent on the general increase of intracranial pressure—there is, at any rate, a close relationship between the two. The cerebro-spinal fluid is forced into and dammed up within the vaginal sheaths of the optic nerve, leading, in the first instance, to an œdema, and later on, to compression of the lamina cribrosa and interference with the circulation. ”

“ A 'jolly good fellow' said: 'Strike at the root of the disease, Doctor!' And smash went the whisky bottle under the faithful physician's cane."
In neuropaths, all irritation to the nervous system is dangerous, and must be eliminated, and to this end, eyes, ears, nose and teeth, all in close touch with nerves and brain, must be put and kept in perfect order.
The Eye. Only 4 per cent, of people have perfect sight. Errors in refraction—common in neuropaths—mean that the unstable brain-cells are constantly irritated. Dodd corrected eye-errors in 52 epileptics, 36 of whom showed improvement. ”

“ They become virtual psychoses. In cases in which the habit can be traced to a peripheral irritation, the cutting off of this by complete section of the afferent nerves leading to the irritable nerve centre will sometimes succeed in effecting a cure. In other cases in which the source of the disorder is probably largely central in the cerebral ganglia, nerve tonics, and sedatives, and generally corroborative treatment are the most obvious means of palliation. ”

“ It is common to explain this on the basis that there is an area of collateral edema about the small necrotic, thrombotic, or hemorrhagic area responsible for the lesion. In short, numerous neurones are functionally rather than structurally affected, or at all events capable of early restitution of function.
3. What is the prognosis in such cases? It appears that now and again patients run for several years without further trouble, both with and without treatment. We are inclined, however, to advocate treatment rather than absence of treatment for a variety of reasons. ”

“ The microscopical changes in neuritis may extend to all of the constituents of the nerve, and present the ordinary picture of acute inflammation, hyperæmia, exudation, accumulation of white corpuscles in the tissues, and even the formation of pus, the nerve-fibres exhibiting in various degrees the destruction of the white substance of Schwann and the axis-cylinder. Or, as in chronic neuritis, the alterations may consist in the more gradual proliferation of the peri- and endoneurium, which, contracting, renders the nerve dense and hard and destroys the nerve-fibres by compression. ”